Background:
Prescription stimulant medications are an important cause of secondary hypertension (HTN) and use is increasing in US adults. Although stimulants are known to increase blood pressure (BP), a systematic approach to assess impact in individual patients is lacking. Further, treating HTN secondary to stimulant use may differ from treatment of essential HTN.
Objective:
To develop a protocol using ambulatory blood pressure monitoring (ABPM) to differentiate HTN secondary to stimulant use from essential HTN.
Methods:
We used ABPM to evaluate pre- and post-stimulant systolic blood pressure (SBP) and diastolic blood pressure (DBP) for patients referred to the BIDMC Hypertension Center. Patient charts were reviewed by a clinical pharmacist to ensure the safety of holding the stimulant medication and to determine the duration of action. Average daytime BP on day 1 (off stimulant) was compared to day 2 (on stimulant) to assess the impact of stimulant on BP. We defined normotension as BP <135/<85 on both days, sustained HTN as BP ≥135/≥85 on both days and stimulant-induced HTN as BP <135/<85 on Day 1 and ≥135/≥85 on Day 2. We also defined an increase of SBP≥10 and/or DBP≥ 5 while taking the stimulant as a clinically significant effect on BP.
Results:
Eleven patients were assessed (see Table). Four had sustained normotension, six had sustained HTN, and one had stimulant-induced HTN. In addition, four of the patients had a clinically significant increase in their BP while on a stimulant. Overall, average increase in SBP was 6.7 mmHg and average increase in DBP was 3.2 mmHg.
Conclusion:
This novel ABPM protocol was useful for differentiating secondary HTN from stimulant use from essential HTN.
Comparison of the Novel Angiotensin II Receptor Blocker Azilsartan Medoxomil vs Valsartan by Ambulatory Blood Pressure Monitoring
